8:30 pm – Resident observed on the floor in the bathroom, no apparent injury, resident states they struck their head on the commode.
8:40 pm – Physical assessment at baseline, neuro checks within normal limits.
8:50 pm – Call physician and receive order to transfer to the ER for evaluation.
9:00 pm – Paperwork completed, ambulance arrives, resident transported to the hospital.
1:00 am – Resident returned from ER; no order changes; neuro checks initiated per physician order.

Sound familiar? You know the drill—unwitnessed falls or falls with possible head injury, resident is transferred to the ER. The majority of ER visits result in a CT of the head, and if negative (many times), the resident is sent back to the facility.

Well, not so fast! Did you know that ischemic stroke risk after falls is significantly higher, even if the resident is treated and released from the ER? A study published in STROKE found that 5.8% of hospitalized patients with ischemic stroke had an ER treat-and-release visit for a fall within 180 days prior to the stroke.

The message is clear—just because a resident is treated and released from the ER doesn’t guarantee that there isn’t something else going on. It might be time to look at your current protocol for post-fall assessments and discuss these findings with your medical director. Residents who experience falls or near misses may benefit from additional, ongoing assessment. Ischemic stroke risk after falls should alert us to take extra precautions. Can we prevent an ischemic stroke? Maybe not, but should we be alert to the risk based on this information? Absolutely! Stay well and stay informed!